SOC 295 – In‑Home Supportive Services Application (Fillable PDF)

The SOC 295 is the official application for California’s In‑Home Supportive Services (IHSS). This program helps eligible seniors and people with disabilities remain safely in their own homes by providing paid caregiver assistance.

Our fillable PDF version lets you complete the entire application directly in your browser—no extra software needed. Simply click the Fill out this form button below, enter your information, and download or email the finished document.

What Is the SOC 295 Form?

SOC 295 collects personal, household, and medical information needed to determine eligibility for IHSS. The form is required for every new applicant and for certain changes to an existing case.

Eligibility Requirements for IHSS

• U.S. citizen or legal permanent resident of California
• 65 years or older, blind, or disabled of any age
• Must have a Medi‑Cal eligibility determination
• Live in a private residence (not a hospital, nursing home, or other licensed facility)
• Unable to live safely at home without assistance

How to Complete the SOC 295 Online

Follow the simple steps in the How‑To section below. The Formize PDF Filler automatically saves your progress, validates required fields, and produces a clean, printable PDF.

Common Mistakes to Avoid

• Leaving required fields blank – the filler will highlight missing information.
• Providing an outdated address or phone number – make sure all contact details are current.
• Skipping the signature page – a signed form is mandatory for processing.
• Using an unofficial PDF version – always start with the official SOC 295 from the California Department of Social Services.

Where to Submit Your Completed Form

After you download the filled‑out PDF, mail it to the address on the last page of the form or fax/email it as indicated. You can also bring a printed copy to your local IHSS office.

Fill out this form – the Formize PDF Filler will open in a new tab.

For the official source, you can also download the PDF directly if you prefer to fill it out offline.